外伤性小脑幕切迹疝的CT诊断与临床应用

目的探讨外伤性小脑幕切迹疝的CT表现。方法对106例经临床证实为外伤性小脑幕切迹疝患者进行CT扫描，观察颞叶钩回及鞍上池、环池、四叠体池和中脑变化，测量中线结构移位数据。其中90例经手术治疗前后对照，16例特重型颅脑损伤患者2h内死亡。结果外伤性小脑幕切迹疝的CT表现为：鞍上池缩小变形或闭塞（97），环池变形或闭塞（93），四叠体池闭塞（66），中脑变形或移位（46）。合并中线结构移位超过15mm认为是小脑幕切迹疝晚期表现。术后对比：术后2d脑疝改善患者部分中脑形态及鞍上池、环池、四叠体池恢复正常，中线移位改善。结论CT检查能早期明确绝大多数小脑幕切迹疝诊断，有助于临床评估伤情，指导治疗。

Clinical application of CT in diagnosing traumatic transtentorial herniation

Objective To recognize CT findings of traumatic transtentorial herniation. Methods CT images of 106 cases with clinically proved transtentorial herniation were analyzed retrospectively. The changes of suprasellar cistern, ambient cistern, corpora quadrigemina cistern, midbrain were observed and the displacement of the midline structure were measured. Among them, 90 cases were operated and compared before and after operation. 16 cases of severe cranio-cerebral injury died in two hours. Results The manifestations of CT in traumatic transtentorial herniation included： displacement or obturation of suprasellar cistern （97）, compression or occlusion of ambient cistern （93）, obliteration of corpora quadrigemina （66）, displacement of midbrain （46）. The displacement of the midline structure beyond 15mm was considered as the manifestation in advanced stage of tentorium hernia. The shrinking and displacement of midbrain, the suprasellal cistern, ambient cistern, corpora quadrigemina, the displacement of the midline were undetectable 2 days after the operation. Conclusion CT is helpful in diagnosing and evaluating the severity of traumatic transtentorial herniation.